NCCIH Research Blog

In an earlier blog post, I explained what we do in the epidemiology program of the National Center for Complementary and Integrative Health (NCCIH). I’d like to share updates on some of my group’s recently published studies analyzing data on pain disparities in U.S. population subgroups. This work addresses Goal 1 of the new National Institutes of Health (NIH)–Wide Minority Health and Health Disparities Strategic Plan, 2021–2025: Taking the Next Steps, to “promote research to understand and to improve the health of racial/ethnic minority populations.” 

Two major reports spurred this work:

• Relieving Pain in America, a 2011 report from the National Academy of Medicine (formerly the Institute of Medicine)
• The National Pain Strategy, released in 2016 by NIH

Each report recommended more population-level research in underserved groups to address pain issues. Since 2014, my colleagues and I have been devising analyses to close this gap. 

Examples of our analyses of pain prevalence and treatment in underserved populations:

• We conducted an analysis of the prevalence and severity of pain among American adults, based on data from the 2012 National Health Interview Survey (NHIS). To my knowledge, this study was the first to assess interactions of race, ethnicity, and language preference in relation to pain in a nationally representative U.S. adult population. 
• We analyzed data from the 2010–2014 NHIS on U.S. military veterans compared with nonveterans, on various measures related to pain. For example, severe pain was about 50 percent higher in veterans than nonveterans, and veterans ages 18 to 39 were twice as likely to have severe pain compared with nonveterans of similar ages. The prevalence of disabling and chronic pain is arguably an indication of suboptimal pain management.
• People with cognitive impairment were among the groups specified by the National Academy of Medicine that “may be disparately undertreated for pain” and need more research. In a study using data from the 2017 NHIS, we found, for example, that cognitive impairment and chronic pain increase each other’s severity and, together, worsen disability and quality of life more than either alone. Clinical practice guidelines generally did not mention how to treat individuals with both conditions.
• We studied chronic musculoskeletal pain and its treatment in American children and young adults with data from the 2007–2015 National Ambulatory Medical Care Survey. We found, for example, that nonopioid medications were the main treatment given, but the use of prescribed opiates increased substantially with age. Older children were more likely to use nonpharmacologic treatments for their pain than children younger than age 13.
• We examined pain chronicity, severity, and impact in U.S. adult Hispanic subpopulations, including by race and by type of Hispanic ancestry with data from the 2010–2017 NHIS. Our findings add to a growing literature detailing large differences in health status among Hispanic subpopulations. 

Currently, we are following up on our pain prevalence data to look at the type and amount of pain-specific health care being used. We hope this work will help identify groups of Americans receiving inadequate pain management and stimulate efforts to improve their health care.